Reform Scotland calls for patients to be ‘drivers, not passengers’

Bigger catchment areas and better information will give people more power to choose their GP

Reform Scotland, the independent, non-party think tank which sets out ways to improve public services, has made a number of recommendations it believes could help end the current “postcode lottery” it has identified in the way people access their GP practice.

Depending on where you live, the report states that the way you can access GP services can be quite different.  For example, whether the practice is open in the evening or at weekends, whether the practice allows you to book appointments or order repeat prescriptions online, or indeed whether the practice even has a website.   And, crucially, this system is a lottery because patients have very little choice over the GP practice with which they can register. 

As a result, in its latest paper, “Patients First: Improving access to GP practices”  Reform Scotland makes a series of practical recommendations which will increase the power of patients and ensure that access arrangements for GP practices meet their needs.  This is fundamental as GPs are the gatekeepers to the NHS and patients need to be able to access care speedily and conveniently.

1. Enlarge GP catchment areas – Putting Patients First. Too much power currently sits in the hands of the GP practice – they can refuse to register patients who live outside their catchment area. Reform Scotland believes the catchment areas should be expanded so that there are more GP surgeries from which patients can choose. This will reduce the effects of the postcode lottery which means that patients can be unable to move from a GP surgery which is not meeting their needs. Instead, there will be a meaningful choice for patients and that choice will drive up standards for all.  Original research by Reform Scotland demonstrates that, with the current restricted catchment areas, where you live will often determine whether you can attend an evening or weekend surgery, or order repeat prescriptions online. Enlarging catchment areas will allow a meaningful choice for patients.
2. Provide more and better information – Putting Patients First. Only through Freedom of Information requests to Scotland’s 14 health board could Reform Scotland construct a picture of GP catchment areas. This information should be made more widely available by GP surgeries in order for patients to make an informed choice based on considerations like proximity, parking, opening hours, service and reputation. As a minimum, GP practices should be required to publish a website under the terms of the General Medical Services contract.
3. Allow new GP practices to open – Putting Patients First. In almost all other areas of the private sector, competition is regarded as a positive driver – why should that be different for GPs, who are private sector workers? There is no reason for the government to protect any private company from competition, and that applies to GPs as much as it does to companies in other industries.

Reform Scotland shares BMA Scotland’s concerns (see note 3) that the current system does not allow small, growing GP practices to receive the funding required to make them financially viable. However, Reform Scotland also believes that the ban on private sector companies opening GP practices should end. The government should make a judgement; either you believe private sector companies should provide GP care or you don’t. If the government believes they should not, it should make all GPs salaried employees of the NHS. Otherwise, it should allow private companies to open surgeries rather than picking and choosing who can do soin an inconsistent manner.

Commenting on the paper, Reform Scotland Director Geoff Mawdsley said:

“Reform Scotland believes that it is simply unacceptable that there is such a wide variation in the way people can access GP services, whilst there is little or no choice over where they can register.

“To help give patients greater choice over their GP practice, we believe catchment areas should be enlarged.  Expanding the catchment area would put no extra pressure on GP practices as they would still be able to close their lists to new patients if they reached capacity.  In practice, many people would still prefer to join the practice closest to them.  However, by enabling patients to move and go elsewhere if they are unhappy with the way they can access services where they are; there is greater pressure on all GP practices to improve. 

“During the completion of this report Reform Scotland was frequently frustrated by the lack of information easily available to the public regarding GP services.   Basic information regarding access arrangements for GP practices, including catchment areas, should be far more widely publicised to ensure patients have a far greater understanding of what services and choices are available to them.  Even without introducing the recommendations in this report, some patients do have a limited choice over their GP, but that choice is pointless if they are unable to find out what they can choose between.

“We believe that our recommendations are sensible, practical and, most importantly, easily introduced.

“No service is perfect, but it is very telling that the top five negatively-rated issues in the Scottish government’s GP survey were all to do with how patients accessed services.  Reform Scotland believes the recommendations we have set out in this report are a step in the right direction and would help improve that experience for patients.”

ENDS